ASSISTING

WITH
AMBULATION
Ambulation is encouraged soon after the onset of
illness or surgery to prevent the complication of
immobility.

Checklist before ambulation

 Determine the client’s activity level and
tolerance for physical exertion
Assess for factor that may negatively affect
ambulation ( eg. Mental status, fatigue, pain,
medication)
 Evaluate the environment for safety (eg.
Presence of obstacle in walkway, adequate
lighting, nonslip floor, handrails)
Check assistive device for safety hazards
Check client's clothing ( eg. Nonslip shoes,
adequate covering for privacy and warmth)
During ambulation, assess client's tolerance of
activity.
Post ambulation, assess client’s recovery from the
activity
Preparing the Client to Walk
The best way to encourage ambulation is to help
the client become and remain as independent as
possible while lying in bed. This include urging the
client to participate in ROM exercises and perform
self-care activities as much as possible.
Crutches are mobility aids used to counter a mobility
impairment or an injury that limits walking ability.

types of crutches
 Forearm crutches are crutches with a cuff at
the top to go around the forearm, and are also
known as the Lofstrand crutch. Forearm
crutches are used by slipping the arm into a cuff
and holding the grip. The cuff, typically made of
plastic or metal, can be a half-circle or a full circle
with a V-type opening in the front allowing the
forearm to slip out in case of a fall.
Forearm crutches
Underarm crutches are used most often by people
with temporary disability or injury. These are used
by placing the pads against the ribcage beneath the
armpits and holding the grip, which is below and
parallel to the pad. These are sometimes known as
axillary crutches.
Strutters.  These are a variation on underarm
crutches, incorporating large soles which remain flat
on the floor or ground while the user walks. They
allow for an improved walking gait, and distribute
body weight to reduce the risk of nerve damage
caused by underarm crutches.
Platform  These are less common and used by those
with poor hand grip due to arthritis, cerebral palsy, or
other condition. The arm rests on a horizontal
platform and is strapped in place. The hand rests on a
grip which, if properly designed, can be angled
appropriately depending on the user's disability.
Canes or walking canes are just one of several devices
available to assist in ambulation, or walking. Using a
walking cane improves balance by increasing a
person’s base of support. When used correctly, canes
unload the leg opposite to the hand the cane is in by
up to twenty five percent.
C cane is a single straight walking cane with a curve
forming a handle at its top. This is the most simple of
all canes. It assists in improving balance by the
mechanism described above. Straight canes should
be used by the patient needing only slight assist with
balance or only minimal unweighting of the opposite
leg.
Functional grip canes are similar to the c cane except
for the handle. A functional grip cane has a straight
grip handle rather than a smooth curve. This allows
for a better grip by the patient. Improved grip allows
for better cane control and hence offers more
support than the c cane. Functional grip canes are
appropriate for the patient who needs slightly more
balance assistance than the c cane provides.
Walking cane with a rectangle base and four small
supports that contact the floor is called a quad cane.
This base provides more support than the above two
canes.
 How to Fit Your Crutches
• Fitting your crutches is the first step to using them comfortably
and safely.
• Ask your doctor, therapist or casting professional to fit your
crutches and provide you with one-on-one instruction.
• The top of your crutches should be about one to two inches
below your armpits when you are standing upright.
• The hand grips of the crutches should be even with your hip.
• Your elbows should bend a bit when you use the hand grips.
• Your shoulders should lean forward slightly while using the
crutches.
• Keep the top of the crutches tightly against your sides and use
your hands to absorb the weight.
• Don't let your armpits rest on the top of the crutches; this can
irritate the skin in your armpits.
 General Safety While Using Crutches

-Watch out for and remove loose items on the floor

such as rugs, electrical cords, toys or anything else
that you could trip over.
- Simplify your household to keep the items you need
handy. Put everything else out of the way.
- Carry a backpack or sling-type messenger bag so
you have a place to put things that are easy to
reach and out of the way.
- Take short steps and rest often.
- Keep most of your weight on your hands rather than
on your armpits.
Standing Up with Crutches
Move to the front edge of the chair.
Hold both crutches in the hand on your injured
side.
Hold the arm of the chair with the free hand.
Put your weight on your good leg, push yourself
up with your arms and stand on the good leg.
 Going Up Stairs with Crutches

If there is no handrail, use both crutches and lead

with the good leg.
Stand close to the step and with your weight on the
crutches; lift the uninjured foot up to the first
step.
Once your weight is on the good leg, bring the
crutches up to the same step.
Repeat this process on each step.
If there is a handrail, use it. Hold both crutches in
one hand, hold the handrail with the other, and
with all your weight on your arms, bring the good
leg up one step. Then bring the crutches up to
that step and repeat for each step.
Different method of walking using crutches

Four-Point Crutch Gait
Indication:
Weakness in both legs or poor coordination.
Pattern Sequence:
Left crutch, right foot, right crutch, left foot.
Then repeat.
Advantages:
Provides excellent stability as there are always
three points in contact with the ground
Disadvantages:
Slow walking speed
Three-Point Crutch Gait

Indication:
Inability to bear weight on one leg. (fractures, pain,
amputations)
Pattern Sequence:
First move both crutches and the weaker lower limb
forward. Then bear all your weight down through
the crutches, and move the stronger or unaffected
lower limb forward. Repeat.
Advantages:
Eliminates all weight bearing on the affected leg.
Disadvantages:
Good balance is required.
Two-Point Crutch Gait

Indication:
Weakness in both legs or poor coordination.
Pattern Sequence:
Left crutch and right foot together, then the right
crutch and left foot together. Repeat.
Advantages:
Faster than the four point date.
Disadvantages:
Can be difficult to learn the pattern.
Two-Point Crutch Gait

Indication:
Weakness in both legs or poor coordination.
Pattern Sequence:
Left crutch and right foot together, then the right

crutch and left foot together. Repeat.

Advantages:
Faster than the four point date.
Disadvantages:
Can be difficult to learn the pattern.
Swing-To Crutch Gait

Indications:
Patients with weakness of both lower extremities.
Pattern Sequence:
Advance both crutches forward then, while bearing

all weight down through both crutches, swing both

legs forward at the same time to (not past) the
crutches.
Advantage:
Easy to learn.
Disadvantage:
Requires good upper extremity strength.
Tripod Crutch Gait

Indications:
Initial pattern for patients with paraplegia l
learning to do swing to gait pattern.
Pattern Sequence:
Advance the left crutch, then the right crutch,
then drag both legs to the crutches
Advantage:
Provides good stability.
Disadvantage:
Very energy consuming.
CANE
Canes are often used to assist in balance, widen ones base
of support, and decrease weight bearing on a lower
extremity. In order to achieve these functions, however,
one must know how to properly use a cane. Here I will
review the appropriate way to walk safely with a cane on
level surfaces.
1) Hold the cane in the hand on your unaffected side so
that it provides support to the opposite lower limb
2) Advance the cane simultaneously with the opposite
affected lower limb
3) Lean your weight through the arm holding the cane as
needed
4) Always have the unaffected lower limb assume the first
full weight-bearing step on level surfaces
Proper Positioning

The top of your cane should reach to the crease in

your wrist when you stand up straight. Your
elbow should bend a bit when you hold your
cane. Hold the cane in the hand opposite the
side that needs support.
Walking

When you walk, the cane and your injured leg swing
and strike the ground at the same time. To start,
position your cane about one small stride ahead
and step off on your injured leg. Finish the step
with your normal leg.
Stairs

To climb stairs, grasp the handrail (if possible) and

step up on your good leg first, with your cane in
the hand opposite the injured leg. Then step up
on the injured leg. To come down stairs, put your
cane on the step first, then your injured leg, and
finally the good leg, which carries your body
weight.
THANK
YOU!!